Medicare AdvantagePrior AuthMedium impact
Ninlaro® (ixazomib) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 25, 2026
Summary
Humana revised its Ninlaro® (ixazomib) prior authorization policy effective January 1, 2026. The policy maintains two approval pathways for relapsed/refractory multiple myeloma: second-line therapy requiring at least one prior therapy combined with lenalidomide/dexamethasone or cyclophosphamide/dexamethasone, and third-line+ therapy requiring at least two prior therapies combined with pomalidomide/dexamethasone. Both require prior authorization with 6-month approval duration. Members with disease progression on Ninlaro are excluded. The revision date of January 1, 2026 indicates recent updates to clinical criteria or evidence standards.
Action Required
By January 1, 2026: Billing and clinical teams must update prior authorization workflows in billing software and provider ordering systems to enforce the two distinct Ninlaro approval pathways. (1) For second-line MM: Verify documentation of at least one prior therapy and confirm combination therapy with lenalidomide/dexamethasone OR cyclophosphamide/dexamethasone before submitting prior auth requests. (2) For third-line+ MM: Verify at least two prior therapies, disease progression within 60 days of last therapy completion, and combination with pomalidomide/dexamethasone. (3) For all requests: Deny or route to clinical review any requests for patients with documented disease progression on Ninlaro. (4) Set all approvals for 6-month duration or clinical review determination. Update prior authorization templates and provider education materials to reflect these specific criteria. Communicate changes to oncology practices and hematology providers who prescribe Ninlaro. Failure to implement proper prior auth controls will result in claim denials for non-compliant requests.